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Carbon Monoxide Dangers

While carbon monoxide may come to mind more frequently during winter months, it’s actually a year-round hazard. Knowing how your family can be exposed to carbon monoxide can keep them safe from this colorless, odorless, tasteless, poisonous gas.  carbonmonoxide

Carbon monoxide is produced when you burn fuel in cars or trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges or furnaces.  It is one of the leading causes of poisoning deaths in the United States. Carbon monoxide poisoning accounts for approximately 40,000 to 50,000 emergency room visits and 5,000 to 6,000 deaths annually in the United States. Yet all instances of carbon poisonings are preventable.

“Carbon monoxide detectors should be installed in addition to smoke detectors. If your smoke detector goes off and there is a fire, you could be exposed to carbon monoxide. However, you can be exposed to carbon monoxide even if there isn’t a fire. That’s why it’s so important to have both a smoke and carbon monoxide detector in the home,” said Ann Slattery, DrPH, RN, RPh, CSPI, DABAT, managing director, Regional Poison Control Center at Children’s of Alabama.

If your carbon monoxide detector goes off:

  • leave the home and immediately seek fresh air
  • call 911 for the fire department to inspect the home
  • call the Poison Control Center at 1-800-222-1222 if there are signs and symptoms of carbon monoxide exposure

The most common symptoms of carbon monoxide exposure are headache, fatigue, dizziness, weakness, nausea, vomiting, chest pain and confusion.

“One of the hallmarks of carbon monoxide exposure is multiple people sick at the same time. Unlike a virus that takes its time working through the household, carbon monoxide will affect everyone in the home at the same time.” Slattery said.

As warm weather approaches, you may already be thinking about your favorite outdoor activities. Keep in mind that you could be exposed to carbon monoxide through:

  • Generators — Don’t use a generator inside the home, garage or basement or near windows. Spring often brings severe weather to Alabama, so be cautious when using a generator during a power outage.
  • Grilling — Never burn charcoal indoors or use a portable camp stove in a garage.
  • Camping — Never use a kerosene lantern inside a tent.
  • Boating — Carbon monoxide from engine exhaust builds up inside and outside the boat in areas near exhaust vents. Swim and play away from areas where engines vent their exhaust. Dock, beach, or anchor at least 20 feet away from the nearest boat that is running a generator or engine. Exhaust from a nearby vessel can send CO into the cabin and cockpit of a boat.
  • Gasoline-powered tools — Never use gasoline-powered tools such as pressure washers and leaf blowers indoors or in a garage, carport or basement. These tools can produce significant amounts of carbon dioxide that can quickly build up to dangerous levels.

The Regional Poison Control Center at Children’s of Alabama was established in 1958. The center handles more than 50,000 poison calls annually, plus more than 60,000 follow-up calls. For more information, visit https://www.childrensal.org/rpcc.

 

Car Seat Safety for Every Age

Car seat safety isn’t just an area of concern just for parents of newborns. As children grow, it is important that they are in an appropriate car seat based on their size.carseatInstall

“There’s no magic one-size-fits-all car seat, so parents need to be familiar with the specific weight and
height limitations of their child’s car seat,” said Marie Crew, coordinator of Safe Kids Alabama and the Child Passenger Safety Resource Center. “A car seat keeps your child in the best seated position for a potential crash.”

Each year, thousands of children are injured or killed in car crashes. Because of children’s bone development and the size of their heads in relation to their torsos, their bodies can be easily injured in a car crash.

A car seat can:

  • hold your child securely.
  • protect your child from hitting something in the vehicle
  • absorb the force of a sudden stop
  • spread the force of an impact safely
  • prevent your child from being crushed by other passengers.

The right seat doesn’t have to be the most expensive one in the store. “When you’re researching seats, check to see what is the highest weight and height the seat can handle. Determine which model your child can use for the longest amount of time,” Crew said.

INFANTS & TODDLERS
All infants and toddlers should ride in a rear-facing car seat until they are at least 2 years old or until they reach the height and weight limits of the seat. Safety experts say rear facing is the safest way for children to travel because it is the best way to prevent head and spinal cord injuries. The most common types of vehicle crashes are from the front or side. Therefore, children who ride in a rear-facing seat have the maximum protection for the head, neck and spine.

TODDLERS & PRESCHOOLERS
When a child has outgrown a rear-facing seat, he should transition to a forward-facing car seat with a harness and top tether until they reach the height and weight limits of the seat.

 

SCHIOOL-AGED CHILDREN
Children who have reached the height and weight limits of their forward-facing car seat should ride in a belt-positioning booster seat until a safety belt fits properly. Seat belts don’t fit children properly until they are at least 4 feet 9 inches and weigh between 80 to 100 pounds, usually between 8 and 12 years old. With a booster seat, the lap belt should fit low across the child’s hips, and the shoulder belt should fit across the shoulder. Children seated in a booster seat in the back seat of the car are 45 percent less likely to be injured in a crash than children using a seat belt alone.

The safest place for all children under the age of 13 is in the back seat of the car.

Parents and other adult drivers can set a good example by buckling up for every single car ride. When children see you use seat belts, you are helping develop lifelong safety habits.

For more child passenger safety tips, www.childrensal.org/ChildPassengerSafety.

Tanning Beds or Sunlight?

It’s that time of year when students get ready for Spring Break and fun in the sun.  Unfortunately, as many teens begin to trade their winter coats for shorts and t-shirts, they may head to the tanning bed to recreate that warm glow.

In fact, some may think going to a tanning bed is safer than being in the sun, since the exposure time is only about 10 minutes.  However, the experts at Children’s of Alabama say the use of tanning beds is why physicians are treating more and more young people for skin cancer.

Indoor Tanning vs. Sunlight

The sun’s rays contain two types of ultraviolet radiation that affect your skin: UVA and UVB.  Tanning beds use UVA light, which penetrates the skin more deeply than UVB rays.  So tanning beds can cause just as much – if not more – damage as the sun.  Plus the concentration of UVA rays from a tanning bed is greater than the amount of UVA rays a person gets from the sun.

Types of Skin Cancer

Studies show that users of tanning beds have much higher risks of basal and squamous cell carcinoma, the two most common types of skin cancer. Doctors also know that young people are more at risk for melanoma, the most serious kind of skin cancer. Melanoma that’s caught early, when it’s still on the surface of the skin, can be cured. But undetected melanoma can grow downward into the skin until it reaches the blood vessels and lymphatic system. These two systems can act like a highway for the cancer cells, allowing them easy access to distant organs like the lungs or the brain. That’s why early detection is so important.

It used to be that mostly older people got melanoma, but doctors are seeing more people in their twenties and even younger with serious cases of skin cancer.  Among teens and young adults, there is an eight- fold higher risk of melanoma among tanning bed users, due to their exposure to concentrated doses of UV rays.

How to Recognize Skin Cancer

There are things you can do to help with early detection of skin cancer, said Traci Duncan, CRNP, a certified nurse practitioner at Children’s of Alabama. “The most important thing is to know your skin, and be familiar with your moles. Know whether a mole has undergone any kind of recent change, whether it’s in size, shape or color.” 

Minimizing Your Risk

The good news about skin cancer is that you have the power to substantially reduce your family’s risk of getting it by taking sun safety seriously.

  • Avoid the strongest sun of the day — between 10 a.m. and 4 p.m.
  • Use broad-spectrum sunscreen (SPF 15 or more) whenever you’re in the sun.
  • Wear a wide-brimmed hat and cover up with long, loose cotton clothing if you burn easily.
  • Stay out of the tanning salon. The risk of developing melanoma is eight times greater among people who use tanning beds regularly.
  • Regularly check for moles and any changes on your family’s skin

Remember, you don’t have to go without a sun-bronzed look. The new generation of self-tanners and body makeups offer easy, realistic results at a reasonable price. Just be sure to use a daily sunblock with an SPF of at least 15 when you go outdoors since fake tanners don’t protect you against sunburn or sun damage.

However, it’s a good idea to avoid airbrush or spray on tans. “The FDA hasn’t approved DHA, the main ingredient in self-tanners for use internally or on mucous membranes like the lips,” said Duncan.“Spray tans may have unknown health risks because people can breathe in the spray, or the tanner may end up on their lips or eye area.”

By taking these precautions, you can insure your family’s skin truly is healthy.

Dr. Robert Cantu talks Concussions

Dr. Robert Cantu, Photo Credit: News Hour

Dr. Robert Cantu, credit News Hour

Dr. Robert Cantu is one of the world’s foremost authorities on brain trauma and concussions in sports. He will speak at our second annual Concussion Summit on Friday, Feb. 27. Dr. Cantu is the author of “Concussions and Our Kids – America’s Leading Expert on How to Protect Young Athletes and Keep Sports Safe.” He is also Senior Advisor to the NFL’s Head, Neck and Spine Committee, Co- Founder and Medical Director of the Sports Legacy (SLI) Institute in Waltham, MA; Medical and Research Director of the Cantu Concussion Center, Concord, MA and Professor of Neurology and Neurosurgery at Boston University School of Medicine.  We asked Dr. Cantu a few questions about what parents need to know about concussions.

How do you know if your child has suffered a concussion? Even if they seem fine, what are some signs and symptoms that may develop later, after the athlete gets home?
The athlete may be sleepier than usual and several days post-concussion may have trouble falling and staying asleep and sensitivity to light or noise by day two or three. Kids are more irritable and have a shorter fuse after a concussion. Concussion symptoms like headache and dizziness can get worse and if they do, a doctor needs to assess the athlete.

What is the most important thing coaches, parents, schools and athletes need to know about concussion and its short and long-term effects?
The most important thing to understand is if properly managed, the overwhelming majority of people will be over concussion symptoms within 8 – 10 days. However, if the concussion is improperly managed, and the athlete remains physically active while symptomatic, they run the risk of second impact syndrome, which can have catastrophic consequences.

Since you are an adviser to the NFL, you get the chance to share your expertise with people at the highest level of the game. What would you say to the little league, middle school and high school athletes (or their parents) who want to be that “star player” – who don’t want anyone to see that they are truly shaken up on the field or on the court?

I want them to understand that playing through a concussion could have dire consequences, including death. If they are properly treated, the time away from their sport while they recover will be lessened.

Registration is still available for the 2015 Concussion Summit – visit http://bit.ly/1aebNnH to sign up.

Preventing and Treating Diaper Rash

Everyone wants a happy, healthy baby, but if your little one is in diapers, then it’s inevitable at some point he or she will likely have a diaper rash.  Diaper rash is a common condition that usually occurs because a baby’s sensitive skin has been irritated by diapers that are left on too long. The same plastic that prevents diapers from leaking also prevents air circulation, thus creating a warm, moist environment where rashes and fungi can thrive.

Diaper rash can be very uncomfortable for a little one, and in some cases may require medical treatment. Some signs of a diaper rash can include:

  • Soreness
  • Redness and red bumps
  • Peeling
  • Irritability

Identifying Infection:

Sometimes a diaper rash can also result in an infection due to yeast or bacteria. Seek medical care if your baby has any of the following symptoms:

  • Blisters or open sores
  • Pus filled sores
  • Fluid seeping from red areas

Traci Duncan is a Certified Nurse Practitioner at Children’s of Alabama with a focus on pediatric dermatology. She says the best way to treat and even prevent diaper rash is to use a barrier cream. Specifically, she says look for diaper rash creams that contain Zinc Oxide to heal and protect your baby’s skin. Duncan recommends smearing the cream on in a thick layer, as if icing a cake at each diaper change.

Types of Treatment:

  • Diaper rash creams with Zinc Oxide
  • Petroleum Jelly

Diaper rash can usually be cleared up by checking your baby’s diaper often and changing it as soon as it’s wet or soiled.  With treatment, the rash should usually go away within 2 or 3 days with home care.  If the rash persists, or if sores appear talk to your baby’s doctor.  You should also seek medical advice if the rash is accompanied by a fever, if there is pus draining from the rash, or if your child is irritable.

Prevention:

Duncan says in some cases, when a baby has sensitive skin, diaper wipes may cause irritation.  She recommends only using wipes in the case of a soiled diaper, not when it’s wet.  Instead, she says use a soft cloth and warm water when it’s just a wet diaper. Then allow the baby’s skin to dry completely before putting on a new diaper. Consider using a barrier diaper cream with each change, if the baby is prone to getting diaper rash.

The following are tips to help prevent diaper rash:

  • Keep the skin dry
  • Allow your baby time without a diaper
  • Change diaper frequently
  • Use warm water and diaper cream with each change

With these simple tips you can help ensure your baby stays comfortable and rash free, which makes for a happy baby and a happy mom and dad.

Pediatric and Infant Center for Acute Nephrology

Dr. David J. Askenazi is medical director of the Pediatric and Infant Center for Acute Nephrology (PICAN) at Children’s of David AskenaziAlabama and Associate Professor of Pediatrics at the University of Alabama at Birmingham (UAB). The PICAN Center works to improve the health and care of infants and children who are at risk for acute kidney disease.

Hospitalized children are at great risk to develop abrupt loss of kidney function. The risk factors for acute kidney injury include toxic side effects from drugs administered to treat a critical illnesses, shock from sepsis, decreased blood flow around the time of surgery and congenital conditions. Reducing those risks, and supporting the failed kidney during this time is the job of the Pediatric and Infant Center for Acute Nephrology (PICAN Center) established a year ago at Children’s of Alabama.

We take a three-pronged approach:

  • Clinical services, which strive to provide the best of care
  • Educational outreach here and throughout the country, which trains physicians and nurses to diagnose and support those with acute kidney damage
  • Research, which leads to a better understanding of the diagnosis, risk factors and outcomes and develops new strategies for prevention and treatment

This all requires coordination and cooperation not only within Children’s but throughout other pediatric care centers at home and abroad.

We are now leading the Neonatal Kidney Collaborative, an international group of more than 20 centers that are interested in the topic of neonatal kidney problems. This collaborative has emerged from observations and studies showing that babies in neonatal intensive care units frequently develop acute kidney injury. It’s not surprising. Normally, babies develop a full complement of nephrons—functional units that make up our kidneys—during the first eight months in the womb. After that, we no longer produce nephrons. However, when born prematurely, nephron production cycle is cut short and babies can end up with fewer nephrons than normal. That can make them more susceptible to short and longterm problems including chronic kidney disease and high blood pressure. By collaborating with other centers, we can look at much broader demographics and much larger numbers of patients, which will allow us to make stronger inferences. Our first study launches in March and will be titled AWAKEN (Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates. This study will improve our ability to diagnose acute kidney injury, understand risk factors, and determine how fluid provision affects kidney and other outcomes.

Meanwhile, Children’s has joined eight other hospitals nationwide to implement a program called NINJA (Nephrotoxic Injury Negated by Just-in-Time Action). This quality improvement project screens every patient admitted to the hospital for medications known to have toxic side effects to the kidney. Historically there has been a tendency to accept this damage as necessary, but we are showing that with risk assessment and daily evaluation of the medications we give our patients, we can reduce the incidence and severity of acute kidney injury. The pharmacy “NINJA’s” look through the hospital census daily and find those who with high risk of toxicity, then they work with care teams to minimize use of these medications, monitor levels of kidney function and to ask the question: “Is it in the best interest of this patient to be on this medicine?” By paying close attention to these risks, we can make a difference in the occurrence or severity of an acute kidney injury.

There are many other initiatives involving our center but one in particular is worth mentioning. It involves a dialysis machine that we are employing for babies. In the past we have relied upon adult dialysis machines for dialyzing babies with kidney failure. Because these machines are not designed for babies, they carry added risk of bleeding and low blood pressure. So we found an opportunity to work with an FDA-approved machine called the Aquadex FlexFlow. It was designed to remove fluids from patients with heart failure but it also happens to be the right size to use on babies. We’ve adapted the machine in the intensive care units of Children’s of Alabama to clean a baby’s blood, remove extra fluid and balance electrolytes. We have been able to do this while avoiding the risks inherent to adult-sized dialysis machine.

Visit our website at www.childrensal.org/pican for more information.

Preventing Dog Bites

Most children don’t think a cuddly dog would ever hurt them, but the fact is about 4.7 million dog bites happen every year in the United States, and more than half occur in children under the age of 14. Sometimes it may be just an innocent nip, but often these dog bites result in a child going to the hospital and even having surgery. Experts at Children’s of Alabama want parents to know that teaching kids about dog safety early on can help prevent the majority of these incidents.

Any Dog Can Bite

Dr. Bert Gaddis of Indian Springs Animal Clinic offers a better understanding of what may cause a dog to bite. Gaddis says first and foremost, it’s important to realize that any dog has the potential to bite. “Any dog no matter the breed or how sweet them seem can be pushed to that point unknowingly”, Gaddis says, “I tell pet owners with children, who probably feel very good around your pet, teach them not to approach strange animals. If it’s a dog with an owner, ask permission to pet that dog.”

Gaddis also says sometimes aggression in animals may be breed related, or even how the dog is raised. If the animal is raised to be defensive, or is often engaged in rough play, the dog may perceive a stranger as a threat even when that stranger is a child. Sometimes dog bites occur when the dog is feeding, and is very territorial around food.  But even the nicest, most well-trained family dog may snap if it’s startled, scared, threatened, agitated, angry or hungry.  And remember, even a small dog can have a dangerous bite.

In the event your child is around an unfamiliar dog, here are some tips to follow:

Interacting with an Unknown Dog:

  • Teach your child to ask the dog’s owner for permission to pet their dog
  • If the owner says yes, move slowly
  • Allow the dog to see and sniff before petting
  • Keep fingers together
  • Avoid sudden, jerky motions

The state of Alabama has had a leash law in place since 1915, but local municipalities have the authority to have their own ordinances to better reflect the needs of the community.

Still, keep in mind, just because there may be a leash law, that doesn’t mean your child won’t encounter a roaming dog without a leash.   It’s important to teach your child to know how to respond when they are approached by a strange dog.

When Approached by a Strange Dog:

Dr. Gaddis offers these important tips if you or your child has an encounter with a strange dog:

  • Don’t Run
  • Don’t Scream
  • Don’t Make Eye Contact
  • Don’t Turn Your Back
  • Back Away Slowlu
  • If a dog does try to bite, put anything you can between you and the dog.
  • If knocked over by a dog, roll into a ball, cover your face and lie still.

Always Supervise

A lot of dog bites can be avoided with parental supervision.  Never leave a child alone with a dog.  And teach children to never tease an animal. Being safe and responsible around dogs is the first step in preventing a dog bite.

New Intensive Feeding Program at Children’s

Dr. Michelle Mastin

Dr. Michelle Mastin

Dr. Michelle Mastin is a clinical psychologist and head of the new Intensive Feeding Program at Children’s of Alabama.

A new Intensive Feeding Program at Children’s of Alabama helps infants, toddlers and adolescents overcome problems feeding and drinking often associated with developmental delays or serious illness. It is the first and only program of its kind in Alabama and one of only a handful of similar programs in the U.S.

The program incorporates pediatric subspecialists, technologies and behavioral psychology into a unique and effective system for teaching both parents and children how to deal with these difficult issues. The program at Children’s is designed in a similar fashion to the one developed at Helen DeVos Children’s Hospital in Grand Rapids, Mich.

The program at Children’s of Alabama is the behavioral psychology component of the new Aerodigestive Program, which encompasses a larger mission of managing complex airway, feeding or nutritional issues. Program specialists evaluate children, develop treatment plans and provide care for a wide variety of conditions using proven, behavior modification techniques coupled with the insight and interventions of speech and language pathologists and occupational therapists.

About half of the program’s patients are expected to be feeding-tube dependent, and in many cases the team will work to normalize the child’s eating and drinking abilities. The Intensive Feeding Program is also capable of dealing with:

  • Food refusal
  • Oral aversion
  • Inability to consume adequate volumes of food and liquid
  • Transitioning to age-appropriate textures, consistencies or utensils
  • Recurrent vomiting
  • Restricted eating patterns

Patients should be referred to the program at Children’s after going through previous attempts to improve their feeding and drinking behaviors. The program is set up to handle tougher, more persistent cases that require multi-disciplined interventions and are often associated with conditions such as gastric esophageal reflux disease, failure to thrive, dysphagia, gastrointestinal problems, developmental disorders, including those on the autism spectrum and behavioral difficulties.

This is an intensive, outpatient program lasting six to eight weeks, five days a week, from 8 a.m. until 5 p.m. Generally, experts will spend about four weeks feeding a child all meals during the week in order to approach identified goals. Care is provided in a room equipped for unobtrusive observation by parents, other caregivers or health professionals.

After that, parents or caregivers will be provided with a small earphone and sent into the treatment room to take over the feeding and drinking interventions. Initially they will be working with their child with the help of therapists. As the caregivers progress and the child demonstrates consistent success, therapists will transition to the observation rooms where they can continue to coach caregivers. It is an effective way to improve the interaction between parents and children at mealtimes.

The results are often impressive. For example, the program at Children’s had its first graduate of the day treatment program in November 2014. This patient was born with significant complex medical challenges, including significant prematurity (born at 22 weeks gestation). The patient came into the program 100 percent dependent upon a feeding tube for nutrition, but was discharged 8 weeks later without the need for G-tube feedings.

Similar programs have been studied and found to be effective. This is a precisely targeted therapy that often succeeds in improving the quality of life for both the child and family. Children’s program is currently evaluating patients weekly and is currently admitting two patients at a time into day treatment. The goal is to expand the program to be able to treat three patients at a time in the second year of the program and four patients at a time in the third year. Referrals forms for evaluation can be found on the Children’s website at http://www.childrensal.org or by calling 205-638-7590.

Holiday Toy Safety

There’s nothing quite like the face of a child unwrapping their gifts on Christmas morning. Whether it’s a new bike or a favorite doll, toys are on every child’s wish list. As parents, we have just as much fun shopping for the perfect gift! But before you run to the toy store, you’ll want to be sure the toys you buy are safe for your child. Every year thousands of children are treated in hospital emergency rooms for toy related injuries.

In order to keep kids safe, you should always ask yourself:

1 – Is this toy safe?

Choking is a particular risk for children three and younger, because they tend to put objects in their mouths. Dr. Terri Coco is an emergency room physician at Children’s of Alabama and an injury prevention expert. She says a good rule of thumb when shopping for younger children, is to see if any pieces of the toy can fit into the tube of a roll of toilet paper. If so, then that toy is a choking hazard. She also points out that even small pieces that are attached to the toy can break off and become a choking hazard for a small child.

Avoid toys with:

  • Small parts
  • Sharp edges
  • Gears
  • Exposed wires
  • Hinges
  • Long strings
  • Magnets
  • Small batteries

2 – Is this toy developmentally appropriate for my child?

Dr. Coco also suggests parents only purchase age appropriate toys for their children. For instance, a bottle of bubbles or a paint set may be fun for an older child to play with, but each could be dangerous if consumed by a younger child. Be sure to read the labels on game and toys and adhere to the age recommendations listed.

3 – Is this toy age appropriate for my child?

The U.S. Consumer Product Safety Commission (CPSC) closely monitors and regulates toys. Any toys made in, or imported into the United States after 1995 must comply with CPSC standards. Remember parental supervision is always key around small children. Be careful that younger siblings don’t have access to toys belonging to their big brother or big sister.

Tips for parents with infants, toddlers and preschoolers:

  • Make sure toys are large enough that they can’t be swallowed (use the toilet paper roll test to be sure).
  • Toys should have soft, smooth edges and no sharp points. Toys should be safe enough to withstand chewing.
  • No strings
  • Avoid toys with batteries

By keeping these tips in mind, you can ensure the toys found under your tree will be safe and bring years of enjoyment to your child. For the latest information on toy recalls, check the CPSC website at www.cpsc.gov.

Not just the joints—treating Juvenile Arthritis

RavelliDr. Angelo Ravelli is considered an international expert in the field of pediatric rheumatology, which affects 50,000 kids across the country. An Italian native, he is traveling halfway across the globe to present his knowledge and research findings with the medical staff here at Children’s of Alabama. We asked Dr. Ravelli what he hoped to share with our clinicians that would in turn help the families they serve.
Here is what he had to say:

Q. What is the one thing you wish people outside of the medical field knew about Juvenile Arthritis?
A. In my view, people should know that although there has been an enormous progress in the care of children with JIA [Juvenile Idiopathic Arthritis] in the last decade and that frequency and severity of permanent disease-related damage has diminished markedly, this illness still causes a considerable burden to children and their families, owing to its protracted course, tendency to flare after treatment discontinuation, potential to induce pain and functional limitations and impact on quality of life related not only to clinical symptoms, but also to the need of long-term administration of medication therapies.

Q: What drew you to pediatric rheumatology?
A: I chose to join the general pediatrics residency program at the University of Pavia, Italy, in 1981, just when the rheumatology program was starting. I then became a pediatric rheumatologist by chance, because the chairmen of the Pediatric Department assigned me to that program. Then, I fell in love with this subspecialty and kept practicing it for the rest of my medical career.

Q. What is your biggest hope for parents and families who are dealing with JIA on a daily basis? Do you think that one day there will be a cure?
A: Nowadays we are able to reach remission or, at least, a satisfactory control of disease activity in most, if not all, children with JIA. In my opinion, the priority in daily clinical care of these patients is the ability to predict and prevent disease flares, which are quite common, particularly after treatment ends. I’m sure that one day there will be a cure for JIA. However, it is currently not possible to foresee when this will happen.

Q. Any comments on the Rheumatology program at Children’s of Alabama?
A. I know that the Rheumatology program at Children’s of Alabama is outstanding and is one of the most active and renown in the US. I know personally Drs. Cron and Beukelman, who are both internationally well recognized and respected authorities in the field. Dr. Cron is the co-principal investigator of the multinational project that has recently led to the development of the new classification criteria in systemic juvenile idiopathic arthritis. He has played and is still playing a fundamental role in ensuring the success of the initiative.

If you are interested in hearing Dr. Ravelli’s presentation, you can view the event live at noon on Thursday, Nov. 13 at http://www.childrensal.org/cme or watch the recorded version afterwards.

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